Coaching Association of Canada

Nutrition Recommendations During the Healing and Recovery Phase

BY: ANGELA DUFOUR, MEd, RD, CSSD, IOC Dip Sports Nutr
SOPHIE JOBIN, BSc AHN, MAHN (c)

Although management of concussions can remain complex, one factor that should never be overlooked is nutrition, which can help reduce overall symptoms and potentially speed up recovery times (1) by:

  • Restoring brain cell activity;
  • Reducing free radical damage and inflammation caused by the injury; and
  • Repairing cellular damage (2).

Concussions are considered to have two main phases:

  1. Healing and recovery; and
  2. Examining the athlete’s ability to return to play (1).

This article will focus mainly on the athlete’s nutritional needs during the healing and recovery phase of a concussion.


FOODS TO EAT DURING THE HEALING & RECOVERY PHASE

Adequate nutrition has the potential to reduce the negative impacts from concussions (1). The most important part of any nutrition recommendation is to avoid deficiencies in energy, vitamins, minerals, and macronutrients: carbs, proteins, and fats (1).

Calories

Concussions, based on their severity, may or may not immobilize the athlete, which makes total energy and nutrition requirements highly variable during the recovery phase (1). Therefore, a sport dietitian must first determine adequate energy requirements in this early stage of management (2).

It is not uncommon for adolescent athletes suffering from concussions to consume fewer calories and maintain a negative balance compared to healthy adults (3). For instance, concussion symptoms such as fatigue, sensitivity to noise or impaired concentration/memory make every day activities like cooking meals undesirable or very daunting, even when hungry (3). This lack of energy intake can disrupt the repair of damaged cells in the brain, causing an overall delay in recovery (3).

Nutritional inadequacies can be minimized by offering athletes some simple nutrition tips (Table 2). Coaches and parents can encourage their athletes to keep a record of their food intake during the healing and recovery phase, as their memory and thinking capabilities can be compromised. This will discourage overeating or under consumption, while encouraging quality food choices (Table 3).

Overall, athletes should consult a Registered Sports Dietitian or concussion specialist to help develop an appropriate nutrition plan that meets their needs and promotes foods high in nutrients that aid in speeding up recovery times (Table 3).

TABLE 2. Nutrition Tips During Initial Recovery
  • Ask a member of the family, loved one or support group to help out with meals during the first week of recovery (when symptoms are worst).
  • Prepare healthy meals that are easy to assemble and/or reheat, such as pre-made salads, pre-prepped fruits and veggies, pastas, casseroles, and one-pot/crockpot meals.
  • Eat smaller meals every three to four hours to help maintain energy levels (blood sugar levels).
  • Prepare small bags of nutrient-dense snacks during the day, such as nuts, trail mix, fruits, vegetables, cheese and crackers, and hard-boiled eggs. This will help avoid unhealthy snacking.
  • If going to the grocery store is a must, try to choose a time when it is less crowded, less noisy, and wear sunglasses and/or ear plugs when shopping.

 

TABLE 3. Foods to Eat
Focus on fruits and non-starchy vegetables
  • Fruits: strawberries, blueberries, cherries, and oranges (1 ½ to 2 cups/day).
  • Non-starchy vegetables: kale, spinach, asparagus, green beans, carrots, and cucumbers (2 to 3 cups/day).

Focus on whole grains

  • Brown rice, oatmeal, whole-wheat bread, pasta, and crackers (3 to 5 oz./day).

Focus on Omega-3s

  • Fishes: Atlantic mackerel, salmon, cod liver, white fish, herring, sardines, and albacore tune (3 to 4 oz. twice a week).
  • Others: walnuts, chia seeds, flaxseeds, egg yolks, hemp seeds, and anchovies.

Choose lean protein sources

  • Seafood, lean poultry and beef, eggs, beans, peas, lentils, soy, low-fat milk, cheese, and yogurt (5 ½ oz./day).

Choose oils and spices

  • Extra-virgin olive oil, safflower and sunflower oil (max 2 to 3 tbsp/day).
  • Garlic, turmeric, rosemary, ginger, and pepper.

Protein

It has been recommended that within 24 hours after injury, the athlete should consume 1 to 1.5g/kg of body weight (BW) per day of protein for the first two weeks after injury (2). For example, an athlete that weighs 150lbs, or 68.2kg, should eat between approximately 68.2 to 102.3g of protein per day (1-1.5g x 68.2kg of BW = 68.2g – 102.3g) This helps limit the inflammatory response and spare protein from being broken down, enabling it to be used primarily for recovery (2).

Other Recommendations

Athletes need to reduce carbohydrate intake, eat healthy fats, and drink plenty of water. It should also be understood that all injuries are different and that everyone responds to treatment differently. As a result, no single nutritional intervention can be proposed (2).


FOODS TO AVOID DURING THE HEALING & RECOVERY PHASE

Most athletes who suffer from a concussion are symptom free within 7-10 days, however research shows that the brain does not fully recover until 21-28 days depending on the severity of the concussion (Figure 1) (4). The importance of proper nutrition during the first month of recovery is critical not only for the athlete’s physical needs, but also for their brain health.

The athlete should avoid foods and substances that (Table 4):

  • Worsen symptoms;
  • Promote inflammation; and
  • Obstruct nerve cell recovery (2).

Therefore, encouraging athletes, coaches, and parents to make nutrition a priority in the healing and recovery phases is of the upmost importance.

TABLE 4. Foods and Substances to Avoid During Recovery
Processed food
  • Fast food, fried food, chips, hot dogs, sandwich meats, and frozen dinners.

Refined sugar

  • Candy, syrups, table sugar, cakes, cookies, pies, sweet rolls, pastries, and dairy desserts such as ice cream.

Refined grains

  • Corn bread, white rice, white bread, grits, refined flour, corn tortillas, crackers, pretzels, white pastas, and corn flakes.

Artificial colours and flavours

Alcohol and caffeine

Sugary beverages

  • Soda, energy drinks, and fruit cocktails. If consuming 100% fruit juice, limit intake to 4 to 6 oz./day

 

Figure 1 . Brain Recovery vs. Symptom Recovery (4)

BOTTOM LINE

Athletes are advised to consult a Registered Sport Dietitian to plan a nutrition strategy during the recovery period and consume approximately half of their overall recommended energy (calories) from protein, or ~ 1-1.5g/kg BW/day, drink plenty of fluids, consume healthy fats, be mindful not to overeat, and eat small frequent meals immediately following the injury (1,2). At this time, it is not clear to list any other specific nutrient recommendations, but more so to ensure that the concussed athlete is meeting their overall energy needs while choosing quality foods that may aid in their road to recovery.

REFERENCES

1. Tipton K. Nutritional Support for Exercise-Induced Injuries. Sports Medicine. 2015;45(S1):93-104.
2. Erdman J, Oria M, Pillsbury L. Nutrition and Traumatic Brain Injury. Washington, D.C.: The National Academies Press; 2011 p. 1-445.
3. Bernitt C, Hoffmann K, Goetschius J, Walton S, Hart J, Malin S. The Effects of Concussion on Energy Expenditure in Adolescents. Journal of Athletic Training. 2017;52(6):175.
4. CCMI - About Concussions Presentation - For Sport Organizations (updated March 1, 2018). 2018